Job Overview
We are seeking a proactive and detail-oriented Pre-Authorization Secretary to join our Buffalo Medical Group team! In this role, you will serve as the first point of contact for insurance pre-authorization processes, ensuring that patient services are authorized efficiently and accurately. Your expertise in medical terminology and office procedures will be essential in managing authorization requests promptly while maintaining compliance with HIPAA regulations. If you thrive in a fast-paced environment and are passionate about supporting healthcare delivery, this is the perfect opportunity to make a meaningful impact at a group that has been treating people well for 80 years.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Review Epic’s queues daily to determine patients who require pre-authorization.
- Complete pre-authorization form by:
* Securing insurance information from Epic
* Review reports in Epic and interpret the clinical information to secure patient’s current medical condition, diagnosis, lab results, and any other pertinent information
- Contact Insurance company as needed and relay all required medical and insurance information to the representative, nurse and/or physician as required
- Answer all appropriate medical questions asked by insurance company.
- Document pre-authorization number, valid dates, medications, CPT code/procedure description and initials in Epic.
- Communicate with referring physician in the instance of denial.
- Communicate with both referring physician and insurance in the instance that the case goes to Medical Review.
- Setup Peer to peer between referring physician and insurance physician.
- Contact and cancel/ reschedule patients when necessary, i.e. cases that are sent for medical review and delayed or not approved.
- Review schedules on a daily basis to assure that all patients who require pre-authorization have been granted pre-authorization with a 24 hour turn around time.
- Work closely with the ordering departments to secure 100% pre-authorization.
- Communicate with co-workers and other staff members to ensure all queues are completed and outstanding issues are followed up.
- Complies with BMG Corporate Compliance policy and HIPPA regulations.
- Any other work as assigned by Supervisor or Manager.
EDUCATION and/or EXPERIENCE
High school diploma or general education degree (GED) required. Two years experience working in a medical office preferred. Strong computer, communication and organizational skills required. Clinical medical knowledge preferred. Exposure to different specialties preferred.
PHYSICAL DEMANDS:
While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
The noise level in the work environment is usually moderate.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Pay: $18.69 - $28.04 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Referral program
- Vision insurance
Application Question(s):
- How many years of medical office experience do you have?
Education:
- High school or equivalent (Required)
Work Location: In person
